Title: Infections of Implanted Cardiac Devices
题目： 植入式心脏装置的感染
Author 作者: Michael Bond, MD

I. Risk factors 风险因素
a. Highest with AICDs (regardless of lead placement site) - 2% infection rate at 5 years
感染率最高的是自动植入型心律转复除颤器（与导线的位置无关） - 5年内的感染率在2％
b. Renal failure 肾功能衰竭
c. Complications at generator incision site 在电源器切口部位发生并发症
d. Devices with multiple leads 多导联装置
e. Re-implantations actually associated with fewer infections
重新植入实际上并不增加感染

II. Infection characteristics 感染特点
a. Most infections d/t S. aureus (rapid onset) and coagulase-negative staph (indolent)
大多数感染是由于金黄色葡萄球菌（快速发作）和凝固酶阴性葡萄球菌（缓发型）
b. 30% of infections do not occur at generator site (lead infection or endocarditis)
30％的感染不会发生在电源器部位（导线感染或感染性心内膜炎）

III. Management 处理
a. Don’t aspirate seromas or hematomas (should be done in OR)
不要抽吸血清肿或血肿（应在手术室进行）
b. Get blood cultures (35% positive in cases of proven infection) BEFORE antibiotics
在使用抗生素前做血培养（在证实的感染病例中阳性率为35％）
c. If concern for endocarditis, go straight to TEE
如果怀疑心内膜炎，直接做经食道超声心动
d. Definitive treatment is to remove everything and treat with antibiotics for 4-6 weeks
根本性的治疗方法是清除感染源，并用抗生素治疗4-6周

IV. BOTTOM LINE 要点
Consider endocarditis in patients with implanted cardiac devices and
fever/constitutional symptoms
对有发烧/全身症状表现的有植入性心脏裝置的患者要考虑感染性心内膜炎

References 参考文献:
1. Baddour LM, Cha YM, Wilson WR. Infections of cardiovascular implantable electronic devices. New England Journal of Medicine 2012;367(9):842-9.
2. Poole JE, Gleva MJ, Mela T et al. Complication rates associated with pacemaker or
implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation 2010;122(16):1553-61.